References

Aarts MA, Rotstein OD, Pearsall EA Postoperative ERAS interventions have the greatest impact on optimal recovery. Experience with implementation of ERAS across multiple hospitals. Ann Surg. 2018; 267:(6)992-997 https://doi.org/10.1097/SLA.0000000000002632

Aiken LH, Sloane DM, Bruyneel L Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014; 383:(9931)1824-1830 https://doi.org/10.1016/S0140-6736(13)62631-8

Balfour A, Burch J, Fecher-Jones I, Carter FJ. Exploring the fundamental aspects of the enhanced recovery after surgery nurse's role. Nurs Stand. 2019; https://doi.org/10.7748/ns.2019.e11437

Brady KM, Keller DS, Delaney CP. Successful implementation of an enhanced recovery pathway: the nurse's role. AORN J. 2015; 102:(5)469-481 https://doi.org/10.1016/j.aorn.2015.08.015

Brown D, Xhaja A. Nursing perspectives on enhanced recovery after surgery. Surg Clin North Am. 2018; 98:(6)1211-1221 https://doi.org/10.1016/j.suc.2018.07.008

Carli F, Bousquet-Dion G, Awasthi R Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg. 2020; 155:(3)233-242 https://doi.org/10.1001/jamasurg.2019.5474

Duriaud HM, Kroman N, Kehlet H. Feasibility and safety of outpatient breast cancer surgery. Dan Med J. 2018; 65:(3)

ERAS Society. Guidelines. 2022. https://erassociety.org/guidelines (accessed 23 May 2022)

Francis NK, Walker T, Carter F Consensus on training and implementation of enhanced recovery after surgery: a Delphi study. World J Surg. 2018; 42:(7)1919-1928 https://doi.org/10.1007/s00268-017-4436-2

Gaudillière B, Fragiadakis GK, Bruggner RV Clinical recovery from surgery correlates with single-cell immune signatures. Sci Transl Med. 2014; 6:(255) https://doi.org/10.1126/scitranslmed.3009701

Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011; 146:(5)571-577 https://doi.org/10.1001/archsurg.2010.309

Jakobsen DH, Kehlet H. A simple method to secure data-driven improvement of perioperative care. Br J Nurs. 2020; 29:(9)516-519 https://doi.org/10.12968/bjon.2020.29.9.516

Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol. 2019; 33:(3)259-267 https://doi.org/10.1016/j.bpa.2019.07.016

Kehlet H. ERAS implementation—time to move forward. Ann Surg. 2018; 267:(6)998-999 https://doi.org/10.1097/SLA.0000000000002720

Kehlet H. Enhanced postoperative recovery: good from afar, but far from good?. Anaesthesia. 2020; 75:e54-e61 https://doi.org/10.1111/anae.14860

Kehlet H. Prehabilitation in surgery—need for new strategies?. Eur J Surg Oncol. 2021; 47:(5)929-930 https://doi.org/10.1016/j.ejso.2020.11.124

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017; 152:(3)292-298 https://doi.org/10.1001/jamasurg.2016.4952

Maessen J, Dejong CHC, Hausel J A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007; 94:(2)224-231 https://doi.org/10.1002/bjs.5468

Myles PS. More than just morbidity and mortality—quality of recovery and long-term functional recovery after surgery. Anaesthesia. 2020; 75:e143-e150 https://doi.org/10.1111/anae.14786

Roulin D, Muradbegovic M, Addor V, Blanc C, Demartines N, Hübner M. Enhanced recovery after elective colorectal surgery—reasons for non-compliance with the protocol. Dig Surg. 2017; 34:(3)220-226 https://doi.org/10.1159/000450685

Specht K, Kjaersgaard-Andersen P, Kehlet H, Pedersen BD. Nursing in fast-track total hip and knee arthroplasty: a retrospective study. Int J Orthop Trauma Nurs. 2015; 19:(3)121-130 https://doi.org/10.1016/j.ijotn.2014.10.001

Watson DJ. The role of the nurse coordinator in the enhanced recovery after surgery program. Nursing. 2017; 47:(9)13-17 https://doi.org/10.1097/01.NURSE.0000522018.00182.c7

The current and future role of nurses within enhanced recovery after surgery pathways

23 June 2022
8 min read
Volume 31 · Issue 12

Abstract

Background:

Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research.

Discussion:

Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy.

Conclusion:

Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.

Enhanced recovery after surgery (ERAS) or fast-track pathways are well established across a wide range of surgical procedures and demonstrate consistent success in decreasing surgical stress, maintaining physiological homeostasis and expediting postoperative recovery (Ljungqvist et al, 2017)(Box 1).

Box 1.Clinical resources

The implementation of ERAS has reduced hospital lengths of stay and surgical complications, so the focus is now on accelerating post-discharge functional recovery and rehabilitation (Kehlet, 2020). Incomplete postoperative recovery, with residual cognitive impairment, sarcopenia and chronic pain for example, will limit the restoration of health and may increase the risk of long-term morbidity (Kehlet, 2020; Myles, 2020).

To help the implementation of ERAS pathways, the ERAS Society (2022) guidelines, which integrate evidence-based practices into multimodal care pathways, have been published for multiple surgical specialties, leading each profession within the surgical team, including nursing, to reconsider their roles and best practice. However, areas of postoperative recovery on the ward and post-discharge rehabilitation are still to be clearly defined in many clinical guidelines.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content